From increasing access to influencing better patient outcomes, health systems are recognizing the benefits of virtual patient visits and remote monitoring—and finding ways to mitigate the costs.
Some patients are harder to reach than others.
Refusing to turn on his webcam, one telemedicine patient insisted on communicating only using the chat box on his provider's mobile app. Eventually, he admitted that he suffered from agoraphobia, germophobia, and social anxiety. This was the only way he felt comfortable seeking care.
Mia Finkelston, MD
Once the realm of science fiction, telemedicine has become a reality of care—and an option for patients that might once have been difficult to reach, including rural patients, professionals with busy schedules, and patients unable or uncomfortable seeking care in person.
Mia Finkelston, MD, medical director at American Well, the patient's Boston-based telemedicine provider says he is the type of patient who might not have received care without access to telemedicine.
Shez Partovi, MD, chief medical information officer at Dignity Health, says his organization alone performed 12,000 telemedicine consults in 2015—a number that he expects will increase to 20,000 in 2016.
But telemedicine is changing, and providers must be ready to exploit its possibilities.
1. Virtual Visit Volumes are on the Rise
Gone are the days when telemedicine was a rarity; appointments are going mainstream.
Shez Partovi, MD
"I can't imagine seeing a primary care provider in the office for a sinus infection anymore," says Deborah Dahl, vice president of care innovation at Banner Health in Phoenix, AZ. She says many traditionally brick-and-mortar services, such as visits for routine acute care, follow up care, e-pharmacy, and counseling are poised to move online.
While Dahl's sentiments may not yet be typical (telemedicine appointments are generally not reimbursed by the Centers for Medicare & Medicaid Services or most other payers), providers are paving the way for virtual visits to become the norm.
"I think more urgent and follow-up care will shift to the virtual space in the near future," says Peter Rasmussen, MD, medical director of distance health at the Cleveland Clinic.
He foresees regular online patient visits with a care coordinator or nurse for health maintenance, and visits to a clinic or doctor's office only for hands-on visits such as eye examinations, throat cultures, and comprehensive physical exam every year or two.
"We are laying the groundwork for a full virtual healthcare system," he says. While Cleveland Clinic's distance health program initially focused on uses such as providing care to rural areas, the ease of access for urbanites and busy professionals has become apparent, says Rasmussen.
2. Better Patient Monitoring Enables Faster Interventions
Being able to reach patients in their home environments has distinct advantages, Dahl says, such as enabling providers to intervene early and influence better outcomes.
Many patients with multiple chronic conditions take numerous medications that have not been checked for interaction, or even for necessity. To verify the necessity and safety of all medications, pharmacists at Banner Health interact remotely with patients via a camera on a tablet or mobile phone and have them go through the medications they take regularly, says Dahl.
After discussing regular medications, they often ask the patient to go into their bathroom and go through their medicine cabinet with them.
"They always have expired medications in their medicine cabinets," says Dahl. Not only is this an opportunity for the pharmacist to ask them to dispose of old medications, but this experience gives the pharmacist an idea what the patient may be taking on a supplementary basis.
A virtual house call is also an opportunity to look at the patient's home environment and intervene before a situation becomes dangerous. Among the conditions visible are fall hazards, squalor, and elder abuse scenarios. Dahl once observed an illicit drug deal happening in the background between the patient's caregiver—her grandson—and a guest.
Suzanne Hinderliter, RN
"The kinds of things you see unintentionally are amazing," she says.
Another sort of remote technology enabling clinicians to monitor for potential danger is the kind that Suzanne Hinderliter, RN, vice president of telemedicine services at OSF Healthcare, in Peoria, IL, says that her organization has adopted.
OSF uses a telemonitoring application "that gathers data from EMRs and bedside monitoring systems." It allows clinicians to see subtle changes to the patient's condition that otherwise might go unnoticed. Hinderliter says OSF has seen a 26% decrease in mortality and a 20% decrease in length of stay system-wide since they began using telemonitoring technology.
3. Partnerships Can Mitigate Costs
Going it alone is going out of fashion.
Dignity Health has historically been hesitant to form partnerships in telemedicine, preferring to remain independent. But that's a notion that is "evolving," says Dignity Health's Partovi.
"We're at a point where we're looking at potentially partnering with other organizations," he says. During the program's growth phase, Partovi and his colleagues wanted to have more control over the services offered and costs associated with the program. But now, they're at a point in their growth where a partnership might be the next step to further growth.
Dignity Health is not alone. Its sentiments are echoed throughout the provider community—with so many different moving parts, it is becoming difficult, if not impossible, to go it alone in telemedicine.
"[Partnering] is almost mandatory," says Cleveland Clinic's Rasmussen, whose organization partners with American Well for technology infrastructure and supplemental clinician staffing.
The cost, he says, is "not an insignificant sum… [but] I don't think we could do the same [in-house] for less."
Peter Rasmussen, MD
OSF has partnered with Carena, a telemedicine provider in Seattle. "We were looking for someone to partner with us, not just provide service… Carena has been very collaborative," says Hinderliter.
The greatest advantage of partnering she sees has been that the infrastructure has already been built, which decreases cost. "If we'd had to build completely in-house, it would have been a lot more." Even when paying clinicians the same hourly wage as an in-house employee, supplemental staffing through a partner is less expensive.
American Well's Finkelston was able to encourage her agoraphobic patient to share more of himself with her over time, starting with a verification phone call, and later a photograph. Eventually, she was able to encourage him to seek in-person care to catch up on missed immunizations and a wellness exam.
"I told him I knew a trick; make sure you get the first appointment of the day. That's when there will be the shortest wait, and the fewest patients in the waiting room." Last time she spoke to the patient, he was willing to engage his webcam. All in all, the patient seems to be in a healthier place, says Finkelston, and she believes he wouldn't have gotten there without virtual care.
She says she wonders, however, how many others like him are out there—and how many routinely go without care.
Lena J. Weiner is an associate editor at HealthLeaders Media.